胸段硬膜外麻醉与全身麻醉下改良根治性乳房切除术术后疼痛的比较：一项随机对照试验

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中文摘要

背景： 乳房手术通常在全身麻醉下进行。本研究的目的是比较胸段硬膜外麻醉与使用喉罩的全身麻醉下改良根治性乳房切除术后的术后疼痛。
材料与方法： 这项随机对照研究在100例接受单侧改良根治性乳房切除术的患者中进行。患者被分为E组和G组，每组各50例。E组患者接受胸段硬膜外麻醉，G组接受全身麻醉。主要目的是比较两组之间的术后疼痛评分。次要目的包括术后咽喉痛、声音嘶哑、咳嗽、恶心呕吐的发生率，围手术期镇痛需求，患者和外科医生满意度，住院和重症监护室（ICU）停留时间，以及任何相关的麻醉并发症。
结果： 两组在人口统计学方面相似。E组在所有时间点的术后疼痛评分均显著较低。G组的围手术期镇痛需求显著高于E组，且具有统计学意义，P < 0.001。两组的住院时间和术中血流动力学相当。G组患者满意度显著更高；然而，外科医生对两种方法均满意。G组的咽喉痛、咳嗽、声音嘶哑、恶心呕吐和ICU停留时间显著更高。硬膜外组有10%的患者需要在腋窝浸润局部麻醉药。
结论： 尽管患者认为全身麻醉更令人满意，但在接受改良根治性乳房切除术的患者中，胸段硬膜外麻醉相比使用喉罩的全身麻醉提供了显著更好的术后镇痛，并且与显著更低的ICU停留时间、相当的外科医生满意度以及更低的术后咽喉痛、恶心呕吐、声音嘶哑和咳嗽发生率相关。

英文摘要

BACKGROUND: Breast surgeries are commonly performed under general anesthesia. The aim of the study was to compare postoperative pain following modified radical mastectomy under thoracic epidural anesthesia versus general anesthesia with the use of laryngeal mask airway.
MATERIALS AND METHODS: This randomized controlled study was performed on hundred patients undergoing unilateral modified radical mastectomy. The patients were assigned into two equal groups, E and G. Group E patients received thoracic epidural anaesthesia, and group G received general anesthesia. The primary objective was to compare postoperative pain scores between the two groups. Secondary objectives included incidence of postoperative sore throat, hoarseness of voice, cough, nausea and vomiting, perioperative analgesic requirement, patient and surgeon satisfaction, duration of hospital and intensive care unit (ICU) stay, and any associated anesthesia complications.
RESULTS: Both groups were similar with respect to demographics. Postoperative pain score was significantly lower in Group E at all time points. The perioperative analgesic requirement was significantly higher in Group G than in Group E, and this was statistically significant with P < 0.001. Duration of hospital stay and intraoperative hemodynamics were comparable between the two groups. Patient satisfaction was significantly higher in Group G; however, surgeons were satisfied with both methods. Sore throat, cough, hoarseness of voice, nausea and vomiting, and duration of ICU stay were significantly higher in group G. Infiltration of local anesthetic in the axilla was required in 10% of the patients in the epidural group.
CONCLUSIONS: Although patients found general anesthesia more satisfying, thoracic epidural anesthesia provided significantly better postoperative analgesia compared with general anesthesia with laryngeal mask airway inpatients undergoing modified radical mastectomy and was associated with significantly lower ICU stay, comparable surgeon satisfaction with lower incidence of postoperative sore throat, nausea and vomiting, hoarseness of voice, and cough.